James C. Salwitz, MD

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Why other professions can’t relate to medicine

Physician

January 15, 2015

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Doctors have a difficult time adjusting to other cultures and because of this flaw, patients, and the medical profession suffer. By culture, I do not mean religious or philosophical background, socio-economic difference, country of origin, nor even the silence created by language and education barriers. I am referring to the communication and comprehension chasms that exist between different occupations and physicians.

What …

Health IT will radically transform medicine. Is it for the better?

James C. Salwitz, MD

Tech

January 5, 2015

It is a heart pounding, head spinning, edge of your seat page-turner; the sort of rare saga that takes your breath away as it changes you, forever. It hints at a radically different future, a completely new world a few years away, which will disrupt the lives of every man, woman, and child. Available now, from the National Coordinator for Health Information Technology (ONC), Office of the Secretary, United States …

Is it time for a suicide certificate?

James C. Salwitz, MD

Physician

December 30, 2014

Physician–assisted suicide: the collaboration of two through a professional relationship, to cause the death of one.

Ever since Socrates took hemlock, suicide has been part of society, sometimes supported, often condemned. Today, many argue that we have a right to die, sort of an infinite extension of free speech or thought. Regardless, to actively involve doctors is a unique distortion of the medical arts, as if stopping a beating heart can somehow …

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Is it time for a suicide certificate?

When the patient’s touch alters the doctor

James C. Salwitz, MD

Physician

December 17, 2014

I do not know about you, but I get confused about the Heisenberg uncertainty principle. Asked for a definition, I usually say something about how when you try to measure something, you change it, therefore one can never be complete or exact in measurement. However, that is wrong. The uncertainty principle has nothing to do with the effects of measurement, but rather its limits. If you measure one thing, such …

Physicians must expand the vision of their role

James C. Salwitz, MD

Physician

December 7, 2014

Once upon a time, in a medical school far far away, I was taught that my sacred oath was to the patient. The one patient; not the patient down the hall, in the next town, or in a country halfway around the world. I would commit my heart, soul, sweat and blood to the suffering and healing of the person directly, immediately in my care. This was a noble calling …

What Mayor Thomas Menino taught us about cancer

James C. Salwitz, MD

Conditions

November 20, 2014

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Beloved and deeply respected Boston mayor Thomas M. Menino died on hospice in Brigham and Women’s Hospital recently. Menino developed advanced cancer of unknown primary (CUP) in the spring of this year, and after six months of chemotherapy, he elected to stop active treatment. Reportedly he was comfortable, and surrounded by friends and family at the time of his death. The press, the …

Oncologists have one of the lowest burnout rates. Why?

James C. Salwitz, MD

Physician

November 14, 2014

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The alarm clock’s blast brings hours of work, running from task to task, always pushing toward the next turn. In moments of failure, the waves of complexity and anxiety batter and you question each stroke. Then you fly downhill, easy breeze in your face, as success urges you on. After the finish, the parking lot empties, the lights go out, and …

The 75 Plan: Thoughts on Ezekiel Emanuel’s palliative care article

James C. Salwitz, MD

Physician

November 6, 2014

When teaching about life near dying, it is hard to achieve open conversation. No matter what one says in a lecture hall or what brilliant writers publish on the terrible state of end-of-life care, change is painfully slow. While we blame evasion by doctors of challenging conversations, failure by patients to plan or denial by families which blocks open communication, the …

Why is medical IT so bad?

James C. Salwitz, MD

Tech

November 1, 2014

A 57-year-old doctor I know is retiring to teach at a local junior college. He is respected, enjoys practicing medicine and is beloved by his patients; therefore, I was surprised. While he is frustrated by the complexity of health insurance, tired by the long hours and angered by defensive medicine, the final straw is that he can not stand the world …

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Why is medical IT so bad?

When hospice is about living, not dying

James C. Salwitz, MD

Physician

October 21, 2014

Not too long ago I suggested hospice to a patient who had progressive cancer, although she likely had months to live. “I don’t think it is time,” she replied, “hospice is for morphine.”

“That is not how I see hospice,” I replied, “I think hospice is about getting the best care and support, even if there is no real treatment for the disease. It is about living well, maybe better. Even …

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When hospice is about living, not dying

When treating seriously ill patients, learn to suppress The Look

James C. Salwitz, MD

Physician

October 8, 2014

A friend of mine plays a mean game of poker. She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments. She is a poker savant. Not long ago I asked her secret to playing the game so well.

“I learned to play cards when I was being trained to treat cancer.”

“Oh,” I said, “the discipline, memorization, patience and statistics?”

“No, that is when I learned not to …

Honoring life: Thoughts on the IOM’s end-of-life care report

James C. Salwitz, MD

Physician

October 1, 2014

The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled ,”Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life.”

This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand. They conclude, as has been said before, that we waste precious resource’s …

A twisted argument against end-of-life care

James C. Salwitz, MD

Physician

September 25, 2014

“All your patients will die. Maybe not today, but someday. The defining fact of life is that it ends. Only a fool would dedicate their career to fighting something that can never be beaten. Therefore, a doctor’s task cannot be to fight death. A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to …

The death certificate didn’t say enough

James C. Salwitz, MD

Physician

September 17, 2014

August 17, 2010. Maris is a 57-year-old woman in excellent health. She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law. A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge.

It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while …

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The death certificate didn’t say enough

What’s it like to be an oncologist? This is just one day.

James C. Salwitz, MD

Physician

September 10, 2014

7:00 a.m. Lights on.

Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday.

Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range …

Allowing medicine to become a commodity would be a disaster

James C. Salwitz, MD

Physician

September 1, 2014

What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list? Gasoline, copying paper and paperclips? Shopping for a mobile accounting office? Nope. What these items share is that who ever makes them, wherever you buy them, they are essentially the same. They are commodities. They do not vary significantly in construction or quality. The only way to …

How we cope with a cancer diagnosis starts in childhood

James C. Salwitz, MD

Physician

August 21, 2014

A baby’s smile reflects the purity in their heart. An infant’s world is a marvelous place of possibility and love. Children see themselves as special, capable, even omnipotent. Time teaches failure, loss, and mortality. How much we lose of that original perfection, that first excitement, that natural confidence, determines how we face the challenges and tragedies of life; whether we will be happy. It may even determine how we cope …

Giving terrible news to those we love

James C. Salwitz, MD

Physician

August 5, 2014

I knew immediately it was a problem. It was not just that Faith’s cancer had spread with innumerable masses in her liver, golf ball-like tumors in her lungs, punched out holes in her bones. It was not that the chemo, third round and toxic, had failed. Those were awful things. Rather it was her response as I began to tell her. As soon as I said, “I looked at the …

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Giving terrible news to those we love

Can doctors really learn from having an illness themselves?

James C. Salwitz, MD

Physician

July 29, 2014

Once upon a time, I was a lifeguard. This was the natural result of swimming fairly well, Red Cross training, and team competition. I saw myself as a handsome, tanned guardian at the ready. OK, I was prone to self-delusion. When I became a doctor I carried over that image of high-perched protector on stilt chair, whistle in hand, rescue float close, ready to dive to the assistance of a …

Doctors are not the only ones who can keep a painful secret

James C. Salwitz, MD

Physician

July 22, 2014

I have written many columns urging doctors to be honest with their patients, especially about difficult news. Too often patients are lead on false hope therapy rides, rather than empowered with honest information so that they can cope with their disease and future. Doctors are not the only ones who can keep a painful secret.

I admitted Sarah to the hospital late on Saturday night. For over two years, she had …